Sudden Sensorineural Hearing Loss in the Department of Defense

2018 ◽  
Vol 159 (2) ◽  
pp. 354-358 ◽  
Author(s):  
Charlotte K. Hughes ◽  
Jakob Fischer ◽  
Carlos R. Esquivel ◽  
Adrienne M. Laury
Keyword(s):  
Primary Care ◽  
Emergency Department ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Medical Record ◽  
Department Of Defense ◽  
Laboratory Testing ◽  
Sudden Sensorineural Hearing Loss ◽  
Intratympanic Steroids ◽  
Nose And Throat

Objective The American Academy of Otolaryngology—Head and Neck Surgery Foundation clinical practice guideline (CPG) proposes recommendations regarding sudden sensorineural hearing loss (SSNHL). SSNHL is managed by primary care, emergency medicine, and otolaryngology providers in the Department of Defense (DoD). However, their adherence to this CPG is unknown. We sought to determine provider compliance and identify areas for improvement. Study Design Case series with chart review. Setting DoD’s electronic medical record. Subjects and Methods Patients with SSNHL (N = 204) were treated between March 1, 2012, and September 30, 2015. Time from onset of symptoms to evaluation by primary care, emergency department, audiology, and otolaryngology providers and treatments were analyzed. Results The average interval from onset of symptoms to evaluation by a primary care or emergency department provider was 4.86 days (95% CI, 3.46-6.26). Time from presentation to ear, nose, and throat and audiologic evaluation was 15.26 days (95% CI, 12.34-18.20) and 14.16 days (95% CI, 11.31-17.01), respectively. Diagnostic workup included magnetic resonance imaging (n = 150, 73.5%), computed tomography (n = 28, 13.7%), and laboratory testing (n = 50, 24.5%). Oral steroids were used in 137 (67.2%) patients, with 78.8% treated with the recommended dose. Intratympanic steroids were utilized in 65 (31.9%) patients, with variable dosing. Conclusion The DoD is uniquely positioned to evaluate adherence to CPGs on national and international levels given the robust and standardized electronic medical record. Areas of improvement include timely identification of SSNHL with rapid referral to ear, nose, and throat and audiology providers; minimizing unnecessary imaging, laboratory testing, and medications; and correct dosing of oral and intratympanic steroids.

scholarly journals COVID-19-related sudden sensorineural hearing loss

2021 ◽  
Vol 2021 (3) ◽  
Author(s):  
Nada Khaleel Yaseen ◽  
Raid M. Al-Ani ◽  
Rasheed Ali Rashid
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Clinical Characteristics ◽  
Smoking Habit ◽  
Hearing Threshold ◽  
Treatment Protocol ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Unilateral Deafness ◽  
Nose And Throat

Background: Sudden sensorineural hearing loss (SSNHL) can be a feature of COVID-19. It may present alone or with other symptoms of the disease. However, there is little written in the literature about its occurrence. We aimed to evaluate the socio-clinical characteristics and outcome of confirmed mild- to moderate COVID-19 cases with SSNHL in Tikrit city, Iraq. Materials and Methods: This descriptive study was conducted at the Otolaryngology Department, Tikrit General Hospital, Tikrit city, Iraq. The period of the study was from December 1, 2020 to June 30, 2021.Mild and moderate COVID-19 subjects confirmed by real-time polymerase reaction were included in the study. Detailed demographic (age, gender, and smoking habit) and clinical characteristics (onset and duration of deafness, side, severity, associated ear, nose, and throat symptoms, and comorbidity) were recorded for every patient. Outcomes following the steroid treatment protocol were also registered. Results: SSNHL was identified in 26 patients, of whom 20 (76.9%) were women, 20 (76.9%) were in the age group ≥ 30 years, and 21 (80.8%) were non-smokers. Around three-quarters of the subjects were identified within the first week of deafness occurrence. Bilateral (18/26) was more common than unilateral deafness (8/26); therefore, the total number of deaf ears was 44. Besides, bilateral symmetrical deafness (13/18) outnumbered the asymmetrical type (5/18). Around three-quarters were of moderate severity. The most common otological symptom was tinnitus (25/26). The most common nose and throat symptom was anosmia (6/26). The mean hearing threshold before and after treatment with oral steroids ± intratympanic steroids was 50.91 ± 11.777 dB and 40.24 ± 15.693, respectively. One patient with bilateral SSNHL was lost to follow-up; the remaining number of deaf ears was 42, and half of them were partially improved. The outcome of the treatment showed no statistically significant relation with the duration, side, and severity of SSNHL (p>0.05). Conclusion: The majority of COVID-19-related SSNHL cases presented within one week of onset, with bilateral outnumbering unilateral cases. Tinnitus was the most common associated symptom. Treatment with steroids achieved partial improvement in half of the cases, and this outcome was not affected by the duration, side, and severity of deafness.

Practice Guidelines for Sudden Sensorineural Hearing Loss

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P58-P58
Author(s):  
David Richard Friedland ◽  
Nima L. Shemirani
Keyword(s):  
Primary Care ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
General Practitioners ◽  
Primary Care Physicians ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Treatment Protocols ◽  
Oral Steroids ◽  
Management Approaches

Objective To identify and compare patterns of treatment for sudden sensorineural hearing loss among otolaryngologists and primary care physicians. Methods A multiple choice and Likert scale survey was mailed to 1,306 otolaryngologists and primary care physicians throughout our state, regarding treatment and management approaches to SSNHL. Survey answers were analyzed by scope of practice and years of experience. Treatment protocols were compared among family practitioners, internists, general otolaryngologists, and otologists. Results A surprisingly large number of general practitioners treat SSNHL independent of an otolaryngologist. General practitioners as a group, however, are significantly less impressed than otolaryngologists that steroids are an effective treatment (p<0.0001). Over 99% of otolaryngologists start oral steroids at evaluation, as compared to approximately 30% of all general practitioners. Of those general practitioners treating on their own, without otolaryngology consultation, 78% use oral steroids. The vast majority of otolaryngologists start therapy with at least 60 mg of prednisone, while lower doses and Medrol dose packs are more commonly used by general practitioners. Otolaryngologists are more likely to treat with steroids beyond 1 week of hearing loss onset, while general practitioners overwhelmingly will only treat within the first week. Over 50% of otolaryngologists also add anti-viral medications. Conclusions Significant differences exist in the management of SSNHL between otolaryngologists and general practitioners. The lack of strong evidence-based guidelines for the treatment of SSNHL may underlie the variability in management by first-line providers.

Intratympanic steroids as a salvage treatment for sudden sensorineural hearing loss? A meta-analysis

2014 ◽  
Vol 272 (10) ◽  
pp. 2777-2782 ◽  
Author(s):  
Jia Hui Ng ◽  
Roger Chun Man Ho ◽  
Crystal Shuk Jin Cheong ◽  
Adele Ng ◽  
Heng Wai Yuen ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Meta Analysis ◽  
Salvage Treatment ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Intratympanic Steroids

Intratympanic methylprednisolone as first-line therapy in sudden sensorineural hearing loss: preliminary results from a case–control series

2011 ◽  
Vol 125 (10) ◽  
pp. 1004-1008 ◽  
Author(s):  
I Dallan ◽  
S Fortunato ◽  
A P Casani ◽  
E Panicucci ◽  
S Berrettini ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Case Control ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
First Line ◽  
Control Series ◽  
First Line Therapy ◽  
Line Therapy ◽  
Intratympanic Steroids

AbstractBackground:Sudden sensorineural hearing loss is a true audiological emergency, and its management is much discussed. Currently, no single therapy has been proven effective according to evidence criteria. Recently, intratympanic application of steroids has been increasingly used in refractory cases; however, it has only rarely been reported as first-line therapy.Materials and methods:Twenty consecutive patients with sudden sensorineural hearing loss treated between July 2008 and January 2010 were enrolled in this prospective, case–control study. Ten patients were treated with intratympanic steroids and 10 with systemic ‘shotgun’ therapy (including steroids, pentoxifylline, low molecular weight heparin and vitamin E). The two groups were homogeneous in all respects. Pure tone averages were assessed before and after treatment for both groups.Results:There were no statistically significant differences between the two groups.Conclusion:Intratympanic steroids seem to offer a valid alternative to systemic therapy, with few risks, in sudden sensorineural hearing loss patients, and we recommend their use as first-line therapy.

Long-term follow up of sudden sensorineural hearing loss patients treated with intratympanic steroids: audiological and quality of life evaluation

2014 ◽  
Vol 128 (8) ◽  
pp. 669-673 ◽  
Author(s):  
I Dallan ◽  
S Fortunato ◽  
A P Casani ◽  
E Bernardini ◽  
S Sellari-Franceschini ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Glasgow Benefit Inventory ◽  
Intratympanic Steroids

AbstractObjective:To evaluate the long-term stability of intratympanic steroids and investigate the ‘real’ impact of sudden sensorineural hearing loss on patients.Method:A total of 14 patients treated with intratympanic steroids were evaluated by audiometric and vestibular examinations. The modified Glasgow Benefit Inventory was used to evaluate quality of life changes after intratympanic steroid treatment.Results:There was no significant difference between pure tone average post-intratympanic steroids and at follow up. The general Glasgow Benefit Inventory score was not significantly associated with the presence of tinnitus or dizziness, or with patient age. The change in pure tone average after intratympanic steroid treatment did not correlate with social or physical scores, but correlated strongly with the general Glasgow Benefit Inventory score (p = 0.0023). Intratympanic steroid administration led to a stable improvement in hearing. Quality of life assessment showed that patients can feel satisfaction regardless of the hearing outcome. Patients who regained a social hearing level expressed greater satisfaction than patients without serviceable hearing. Overall, quality of life improvement was not related to hearing improvement.Conclusion:Sudden sensorineural hearing loss is devastating. Considering the audiological effects alone ignores the ‘human’ perspective. Audiological success can correlate with poor quality of life outcome.

scholarly journals Management of sudden sensorineural hearing loss among primary care physicians in Canada: a survey study

2021 ◽  
Vol 50 (1) ◽  
Author(s):  
Benjamin Ng ◽  
Matthew G. Crowson ◽  
Vincent Lin
Keyword(s):  
Primary Care ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Primary Care Physicians ◽  
Tuning Fork ◽  
Family Physicians ◽  
Sudden Onset ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Medical Emergency

Abstract Background Sudden Sensorineural Hearing Loss (SSNHL) is a medical emergency requiring immediate attention as delayed treatment can lead to permanent and devastating consequences. Primary care physicians are likely the first to be presented with SSNHL and therefore have the crucial role of recognizing it and initiating timely and appropriate management. The aim of this study was to gain insight into the current knowledge and practice trends pertaining to the diagnosis and management of SSNHL among family physicians in Canada. Methods An 18-question survey targeting Canadian family physicians was marketed through two, physician-only discussion groups on the social media platform Facebook. Responses were collected between August 1st and December 22nd 2019 then aggregated and quantified. Results 52 family physicians submitted responses. 94.2% (n = 49) reported that in their practice, unilateral SSNHL warrants urgent referral to otolaryngology and 84.6% (n = 44) reported that unilateral sudden-onset hearing loss warrants urgent referral for audiological testing. 73.1% of participants (n = 38) reported that they would attempt to differentiate between conductive and sensorineural hearing loss if presented with unilateral, acute or sudden-onset hearing loss. 61.5% (n = 32) would rely on tuning fork tests to inform management decisions, as compared to 94.2% (n = 49) relying on case history and 88.5% (n = 46) on otoscopy. 76.9% (n = 40) would prescribe corticosteroids if presented with confirmed, unilateral SSNHL. Conclusion The majority of family physicians in the study would make appropriate referral and treatment decisions in the management of SSNHL, understanding it is a medical emergency. Tuning fork tests are under-utilized for informing management decisions compared to other means of differentiating conductive and sensorineural hearing loss. Further research is needed to understand why some family physicians do not prescribe corticosteroids for treatment of SSNHL, which may then identify any gaps in knowledge or inform improvements in clinical protocol. Graphical abstract

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